Objective To describe the method and review the outcome of reconstruction ofⅠandⅡdegree defect of thumb and finger by p artial transplantation of distal to e tissue from the great and /or second toe.Methods A series of 65cases with 71ⅠandⅡdegree thumb and finger defect were r econstructed.Of those,49were thumb defect,12index finger,5middle finger and 5ring fin ger.In 6cases,two digits were reconstructed simultaneously at th e same setting.For thumb reconstruction,the donor transplants were har-vested from great toe in 14cases,fro m 2nd toe in 35cases.All finger recon struction cases were taken from2nd toe.Results Postoperative arterial crisis occu rred in 10digits and venous crisis in4.All digits survived after operative and medication trea tment.Twenty digits underwent seco ndary plastic operation for better c os-metic effect.Forty-two digits in 38cases followed-up from 6months to 13years revealed good pulp pinch function.Sensation recovery to S3 + and above in 30cases(34digits)and two-point discrimination from 6-8mm in 30digits.The patients were satisfied with the appearance of the reconstructed thumb and fingers.There were no major complication in the don or toes.Conclusion The defect of distal segment and finger tip of thumb and /or finger can be reconstru cted by transplantation of partial t issues from the great,2nd or /and 3rd toe.The operation will not be influenced by anomaly of the blood vessels.Both ultimate function and cosmetic effect can meet the patientsdesire.[

Objective To introduce the outcome of compound defect in the hand treated by compound flap transfer or combined flaps transfer. Method From Dec.1983 to June 2001,thirty-five cases with five kinds of compound defect in the hand were treated surgically.Among them,four cases with defect of skin and extensor tendon in the dorsum of hand were repaired by dorsalis pedis flap with tendons;Three cases with longitudinal subtotal loss of distal thumb and one case with longitudinal subtotal loss of distal middle finger were reconstructed with fibular segmental osteo-onychocutaneous flap from great toe or tibial segmental osteo-onychocutaneous flap from second toe;Eight cases with total or subtotal defect at middle part of thumb or fingers were reconstructed with segmental second toe; seventeen cases with defect of thumb and hand skin were reconstructed with combined transplantation of second toe and free skin flap;Two cases with middle finger defect at the base of proximal phalanx were reconstructed with bridging transplantation of bilateral second toe. Result Thirty-three cases were successful.Follow-up period ranged from 0.5 to 5 years postoperatively.The excellent and good rate was 82.9% assessed with provisional functional assessment criterion for upper limbs issued by Chinese Society of Hand Surgery. Conclusion The compound flap transfer or combined flaps transfer was an ideal method in repair of compound defect in the hand.

Objective To report the result of bilateral second toes transfer for reconstruction of total hand or total digits defect. Methods A series of 14 total hand or total digits defect were reconstructed by transplantation of 2nd toes from both feet forming a crab-shaped hand. Among 14 cases, 11 cases were males and 3 females. The patients were aged from 4-44 years, with an average of 22.7 years. One of the 14 cases was of congenital deformity and the other 13 were caused by trauma. The 14 cases were classified into three types according to the level of amputation; Type Ⅰ: defect at the distal end of the metacarpal bone with good function of abductor pollicis in 6 cases; Type Ⅱ: at the proximal end of carpus or the level of wrist joint in 5 cases; and type Ⅲ: at the forearm end stump in 3 cases. All the operations were successful. Results All 28 transferred toes survived uneventfully with good blood supply and pulp fullness and elasticity. Follow-up examination made at mean 6.6 years postoperative period (2-15 years) showed that mean total active motion (TAM) of IP joints of reconstructed digit was 57.5? (35?-105?). All the 14 cases had restored digital function, such as opposition of the fingers, pinching a pencil, a key, a needle or holding an ink-bottle. The mean distance between the two reconstructed digital pulps was 4.3 cm (2.6-6.5 cm). Judging by the evaluation standard of British Medical Institute, sensation recovery to S3+ was obtained in 20 digits of 10 cases. Based on the trial criteria of the function of hand reconstruction of hand surgery society of Chinese Medical Association, 2 were assessed as excellent, 7 good, 4 fair and 1 poor. Conclusion Reconstruction of crab-shaped hand for total hand or total digits defect by transfer of bilateral 2nd toes with metatarso-phalangeal joint can give the patient reasonable prehensile function without much impairment to foot function.

Objective To improve the resistance exercise apparatus of climbing ladder with load on rats, and to observe the technological, athletic training and biological response to the improved experimental apparatus.Methods Thirty-six healthy SPF male Sprague-Dawley were randomly divided into control and exercise groups.The climbing ladder and weight bearing device were separately improved to develop a new resistance exercise apparatus of climbing ladder with load on rats.The exercise group took an 8-week incremental exercise program using this improved device.To observe the operation effect of this improved exercise apparatus.To observe the dynamic changes of average maximum load on SD rats from the exercise group during 8 weeks.To compare the effect of climbing ladder exercise with load on body weights of SD rats between the two groups.Results The improved climbing ladder was marked by the prioritization technique of architecture stabilization, weight bearing and easy cleaning.The improved bearing device has the advantages of being sturdy and durable, and simplemethod to calculating load.Moreover, the new experimental apparatus can be operated by one person during the exercise program.The average maximum load was successfully increased to 756 g after an 8-week exercise using the improved apparatus.Compared with the control group, the body weights of SD rats from the exercise group after training were significantly reduced (P<0.05).Conclusions The improved resistance exercise apparatus of climbing ladder with load can provide a more endurable and repeatable process in the study of rat strength training and it is recommended to use this new device in future experimental research.

Objective To investigate the diagnostic value of microscopic observation drug susceptibility assay (MODS) in extrapulmonary tuberculosis. Methods MODS technology was constructed by using 24-well cell culture plate and liquid culture.Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS were used to detect Mycobacterium tuberculosis in 74 pleural fluid samples collected from patients with tuberculous pleurisy,63 cerebrospinal fluid samples collected from patients with tuberculous meningitis and 18 samples collected from non-tuberculosis suspects.The immunochromatography was used to distinguish Mycobacterium tuberculosis from nontuberculosis mycobacteria. The results of Ziehl-Neelsen smear, Lowenstein-Jensen culture and MODS were compared by x2 test.Results The positive rates of MODS,Lowenstein-Jensen culture and Ziehl-Neelsen smear were 58.1 ％ (43/74),18.9 ％ (14/74 ) and 6.8％ (5/74),respectively in tuberculous pleurisy patients; 54.0％(34/63),20.6％ (13/63) and 4.8％ (3/63),respectively in tuberculous meningitis patients.The positive rate of MODS technology was significantly higher than that of Lowenstein Jensen culture in tuberculous pleurisy patients (x2 =24.00,P＜0.01) and tuberculous meningitis patients (x2 =14.97,P ＜ 0.01). Each Mycobacterium obtained from MODS and Lowenstein-Jensen culture was identified as Mycobacterium tuberculosis by immunochromatography.All of the 18 pleural fluid and cerebrospinal fluid samples which collected from non-tuberculosis suspects were all negative detected by Ziehl-Neelsen smear,Lowenstein-Jensen culture and MODS.The median time to culture positive of MODS was 9 days in cerebrospinal fluid and 14 days in pleural fluid samples,which were both significantly shorter than that of Lowenstein-Jensen culture (31 days in both cerebrospinal fluid and pleural fluid samples). Conclusion Compared to conventional microbiological diagnosis methods,MODS is a rapid detection method of Mycobacterium tuberculosis with a higher positive detection rate,which is suitable for rapid diagnosis of extrapulmonary tuberculosis.

OBJECTIVE To understand the status quo for hospital infection hospital infection to provide a scientific basis. METHODS A cross-sectional survey was taken combined with the hospital bedside investigation and records investigation. RESULTS In 1033 cases,the prevalence rate was 3.87%,and the infected sites were the respiratory site,superficial incision,skin and soft tissue. Utilization rate of anti-bacterial drugs was 60.31%,the pathagen detection rate before treatment was low only 7.73%. CONCLUSIONS Prevalence rate survey method is simple and reliable,it may be the basic reflect of hospital infection. Further strengthening the management of invasive operations,regulateing the rational use of antibiotics status quo,improving the detection rate of pathogens and reduceing preventive medication and antibiotic usage are all evitable.

Objective To evaluate the efficacy of prevention of recurrent femur fracture in children with osteogenesis imperfecta.Methods Data of 35 patients (19 boys,16 girls) who were treated for femur deformity due to osteogenesis imperfecta at our hospital from Jun 2009 to Jun 2013 were retrospectively analyzed.The average age of the patients was 9 years 3 months,ranging from 3 years 6 months to 13 years 1 month.All the patients had suffered from recurrent femur fractures before which led to femoral deformity.The mean angulation angle was 55° (range,10°-90°).10 patients were operated at one side;the other 25 patients were treated bilaterally.None of them received operation before for fractures.The average incidence of femur fracture before operation was 2.4/year (range,2-4).According to the modified Sillence classification system,9 were type Ⅲ OI,14 type Ⅳ,and 12 type I.The curved deformity of the femurs were corrected by osteotomy and stabilized by telescopic intramedullary rods in 35 patients.Results All the 35 patients were followed up for a mean period of 62 months (range,36-72).The average healing time of the osteotomy site of the femur was 8.5 weeks (range,7-12).The patient was encouraged to begin weightbearing and walking when the Xray film showed healing of the osteotomy site.By the latest follow up,80％ of the patients could stand and walk independently.The incidence of femur fracture decreased significantly to the level of 0.3±0.1/year,compared with the level of 2.4± 1.3/year before operation.All the parents of the children were satisfied with the result of deformity correction.At the latest follow up,the Barthel index score increased from 71.82 (range,51-92) before operation to 92.32 (range,82-100) postoperatively,while the WeeFIM score increased from 53.32 (range,42-72) before operation to 78 (range,70-86) postoperatively.The difference of Barthel index score and WeeFIM score between that before and post operation was significant.The children's selfcare and motion ability improved obviously after operation.During follow up,22 patients suffered from recurrent fracture of the femur by various degree,7 of them were treated by open reduction and telescopic rodding surgery,while the other 15 patients were treated conservatively because the fracture displaced or angulated minimally and the fracture healed uneventfully.Conclusion The telescopic intramedullary rod can maintain the correction of the femur deformity and improve the quality of the bone,thus prevent the recurrent fracture of the femur in children with osteogenesis imperfecta effectively.

Objective To explore the means of haemostasis in gallbladder preserving cholecystolithotomy. Methods The clinical data of 31 cases were retrospectively analyzed, summarizes the successful experiences. Results There appeared 31 cases the gallbladder internal bleeding in 512 cases gallbladder preserving cholecystolithotomy. In all the cases, 31 operations were stopped bleeding satisfactorily and performed successfully without conversion to conventional laparoscopic surgery, without perforation of gallbladder. pressure and lavage hemostasis had common effect, the control coagulation hemostasis had satisfaction rate 96.6%. Except one patient used gallbladder whole layers suture method. Conclusion The control coagulation hemostasis with the high-frequency electric knife is the optimal way, pressure and lavage hemostasis is basal, and gallbladder whole layers suture method is supplement.

Objective To introduce the concept of long length finger reconstruction and our corresponding three operative methods. Methods In a series of 10 finger defect cases with one of their long finger amputated at or proximal to proximal phalanx, long finger reconstruction were accomplished with one of the three methods. First method: For emergency patients whose proximal finger segment were demolished, the donor second toe was transplanted intercalatedly with microsurgical technique between the original proximal finger stump and the saved distal finger segment. Second method: Bilateral second toes were harvested and connected together to form a long transplant in order to reconstruct a normal length finger. Third method: From one foot, the donor second toe is harvested with its dorsal and plantar skin flap. From the other foot, the second toe is harvested with its metatarsophalangeal joint and skin flaps from neighbouring sides of great and third toes. The skin covering will be perfect. During transplantation of the proximal transplant, the MPJ should be fixed at 90°plantar rotation position for better flexion. Results Uneventful survival of reconstructed fingers were obtained in all ten cases. Postoperative functional evaluation of the patients with standard set by Chinese Society of Hand Surgery showed to be excellent in 1 case, good in 5 cases and fair in 4 cases. The overall excellent/good rate was 60%. Conclusion By application of these three reconstruction methods, the challenging problem of long length finger can be solved to reasonable extent.

ObjectiveTo investigate the protective effects and mechanism of ursodeoxycholic acid (UDCA) on α-naphthylisothi (ANIT)-induced cholestatic liver injury in rats.MethodsA total of 48 Sprague-Dawley (SD) rats were selected.Fouty-two rats were gavaged with ANIT (100 mg/kg) to induce acute liver injury,six rats were sacrificed 24 hours after the liver injury and the rats left were evenly divided into control group which were gavaged with saline and UDCA group which were gavaged with UDCA (20 mg/kg).Six rats were sacrificed at 48 hours,72 hours and 96 hours after modeling.The six untreated rats were set as blank control group.Serum and liver tissues of all rats were kept after sacrificed.Serum levels of alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil) and total bile acid (TBA) were tested,interleukin-10 (IL-10),interleukin-6 (IL-6),and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay (ELISA).The expression of multidrug resistance associated protein2 (Mrp2) at mRNA level in liver tissue was measured by quantitative real-time polymerase chain reaction (qRT-PCR) and the inflammatory reaction activity of liver tissues was inspected with Haematoidin-Eosin (HE)staining under microscope.ResultsAt 48 hours after liver injury modeling,serum TBil (143.80± 12.08) μmol/L vs.(178.50±15.19) μmol/L,TBA (13.15±3.81) μmol/L vs.(21.68±7.93)mol/L,IL-10 (44.13±3.68,37.15±6.25 ng/L),IL-6(50.80±2.09,57.32±4.63 ng/L) and TNF-α (17.53±0.84) ng/L vs,(19.10±1.64) ng/L of UDCA group and control group were compared,and the differences were statistically significant (P ＜ 0.01 or P＜ 0.05).At 72 hours after liver injury modeling,serum ALT (721.67±97.54) U/L vs.(929.50±148.29) U/L and IL-10 (54.68±6.79)ng/L vs.(43.85±4.08) ng/L of UDCA group and control group were compared,and the differences were statistically significant (P＜0.01 or P＜0.05).At 96 hours after liver injury modeling,serum ALT (156.83±14.99) U/L vs.(250.67±42.29) U/L,AST (143.67±27.45) U/L vs.(206.00±63.94) U/L and TBil (23.53±5.08) μmol/L vs.(34.02±9.98) μmol/L of UDCA group and control group were compared,and the differences were statistically significant (P＜0.01 or P＜0.05).The differences of Mrp2 expression at mRNA level in liver tissues between UDCA group and control group at 48 hours (0.77 ± 0.21,0.46 ± 0.25),72 hours (2.27 ±0.84,1.10 ±0.38) and 96 hours (3.64±0.54,2.75±0.69) after liver injury modeling were statistically significant (P＜0.01 or P＜0.05).ConclusionThe mechanism of the protective effects of UDCA on ANIT-induced liver injury may be related with the regulation of serum cytokines and liver Mrp2 expression.